Approach to a child with diarrhea

Assessment of a child with diarrhea involves a detailed history and physical examination.

History regarding the duration of diarrhea, nature of stools, frequency of stools, odor and colour of stools, presence of blood and mucus, presence of fever, vomiting, abdominal pain and tenesmus, time of urination, presence or absence of thirst and general activity of the child should be obtained.

The child's pre-illness feeding history regarding breast-feeding, bottle-feeding artificial feeding, immunization status especially regarding measles vaccine, details of fluid intake, any prior medication or any concurrent illness should be obtained. Urine output characteristically is decreased with dehydration.

•  Respiratory symptoms such as cough or dyspnea may indicate presence of an underlying pneumonia.

•  Urinary frequency, urgency or pain may suggest urinary tract infection,

•  Earache may be a symptom of acute otitis media, and

•  High fever with altered mental status may be signs of meningitis or sepsis.

•  Acute onset diarrhea with watery or rice-water like stools with a high purge rate with or without vomiting and rapid onset of severe dehydration should arouse suspicion of cholera.

•  In lactose intolerance the child has explosive watery diarrhea in associated with abdominal distention, borborygmi, flatulence and excoriation around the diaper area.

History may help differentiate viral from bacterial causes of diarrhea. Bacterial diarrheas are more commonly associated with fever, abdominal pain, tenesmus and presence of blood and mucus in stools. Viral diarrheas usually have associated emesis and they occur seasonally.